March 9, 2012

Says Nick Gillespie, quoting Virginia Postrel. That's the libertarian analysis. But isn't there some need for a doctor's exam? Obviously, the doctors must think so, and they have so much to gain if Obamacare covers everything. Meanwhile, Instapundit notes that his "wife’s heart attack was probably caused by birth-control pills." You can say the doctor's visits she had didn't prevent that, but would there be even more heart attacks and other calamities if women could just grab these items off the shelf? I have no idea, but then I never liked the idea of taking pills for birth control. Pills change the structure of your body, including your brain, do they not? You become a different person. Not that I thought I was such a wonderful person — back in the pre-self-esteem days — but I wanted to know that whatever I was was really me and not a drug.

116 comments:

I'm not sure it solves the controversy. The same mandate requires coverage for breast pumps, which are absolutely OTC, non-prescription items. It is also somewhat unclear whether it covers the morning after pill, which is OTC.Also, I didn't think the controversy was about the doctors appointment (which will be covered), but paying the $9+/month at all.

Gee, now Reynolds is also a cardiologist? Who knew! And what's funny, is that the post he links to about his wife's heart attack doesn't even mention birth control pills (although it does mention prescription anti-depressants).

Freder Frederson said...Gee, now Reynolds is also a cardiologist? Who knew

Yes, because let's pretend you are a doctor or at all knowledgeable about medicine!

And what's funny, is that the post he links to about his wife's heart attack doesn't even mention birth control pills

From Dr. Helen in the comments;

Docs say perhaps a blood clot got caught in one of these arterial spasms and caused the heart attack. I was on birth control pills at the time and was told that could possibly have caused the blood clot--I have never taken them since.

I find it very difficult to understand how all my memories, perceptions, and feelings can be contained in the molecules that are my brain. Apparently, every time someone merely says one word to me, it changes the structure of my brain. That said, infusing these molecules with drugs seems like a very bad idea. It has nothing to do with what the human body evolved to be. But then, I have my coffee in the morning and my glass of wine at night, so what am I talking about?!

And isn't it funny that even now, 50+ years after it was introduced, we still call birth control drugs "the pill" or "pills?" When you think about all the pills people take now; but when a woman says "I'm taking the pill," we know she doesn't mean Vicodin or Xanax or Lipitor.

IIRC, there are a lot of variables in dealing with a woman's reproductive system and we heard about many recalls of birth control methods in the early days, especially IUDs.

MayBee, damikesc, and Chuck are all correct.

One problem here is that the doctrinaire Libertarians, often assumed to be more or less Conservative, line up pretty much with the Lefties on social and foreign policy issues.

Freder Frederson said...

Gee, now Reynolds is also a cardiologist? Who knew! And what's funny, is that the post he links to about his wife's heart attack doesn't even mention birth control pills (although it does mention prescription anti-depressants).

What a putz.

If Freder used his brain (I assume he has one) instead of his mouth and his talking points, he'd know that various birth control methods have been directly or indirectly linked to a great many ailments.

(CBS) Birth control pills have been tied to several side effects, including nausea, vomiting, cramps, and even hair growth. But a new study suggests another possible side effect women might experience while taking the pill:

Does the pill enhance that? Interfere with it? Or turn it into something else entirely?

Timely question.

Here is an answer:

Women who have a strong libido should stay off the Pill when choosing a partner, according to a study. On the other hand, the contraceptive could benefit those preferring cosiness to passion, the research claimed.

Scientists discovered there were pros and cons to starting a relationship while on the Pill.

OCPs are quite safe. They have a long history of use, and the side effects and risks are well known.

For most women, as long as you aren't a smoker, the MD visit is more for the Pap smear than any detailed discussion of which OCP to use, or whether.

MD/NP/PA vists are best for the nuances of choices between OCP options, and follow up of complications.

But medicine is a guild and wants to control access to the Holy Prescription as long as possible.

I'm not a total libertarian on this. I don't think people can safely self-prescribe Hunira or chemo or even most cardiac drugs.

But OCPs?Meh. An online questionnaire should suffice in weeding out those who should see a "Provider" first. it would save a whole lotta dough and time for women, avoiding that visit. Although tying Pap smears to OCP Rx seems smart from the MD side, for women it's not very fair.

Some people drop LSD, eat mushrooms, smoke pot and drink booze but worry about organic food and are scared to take prescription medicine.

I know, right? Worrying that your food might not be organic while dropping LSD and taking prescription medicine seems ironic, no?Much like being all in favor of fetal stem cell as the next big medical cure while being concerned about genetically modified corn.

In reality, it is all very consistent if you realize it's about social justice, at least for the activists.

I suppose it depends on how you define "use." I'll grant you that it's likely that the majority (perhaps the vast majority?) of commenters here are male. But even so, and quite apart from condoms and the occasional vasectomy, in a sense couples "use" birth control. (When my husband and I were, I did think of it as "we," in terms of family planning.) Now, I would feel reasonably comfortable in saying that it's likely that it's the women have used more *types*, or at least are more, well, *likely*, to have done so.

I never liked the idea of taking pills for birth control. Pills change the structure of your body, including your brain, do they not? You become a different person. Not that I thought I was such a wonderful person — back in the pre-self-esteem days — but I wanted to know that whatever I was was really me and not a drug.

YES. You see, those of us "extremists" who do not bow down to the altar of contraceptives are not so evil and anti-woman after all.

How is it respectful of women to say that the naturally-given unaltered state of the bodies of women is so fundamentally inferior that they need to take powerful body-changing chemicals in order to be equal to men?

Bill- yes, that talking point came from Fluke. And yes, Catholic institutions, including Georgetown, pay for contraceptive pills if used for non-contraceptive medical reasons.And just in case you are about to ask, no, they don't cover Viagra.

I used BCPs (not continuously, but rather at separate times) for only about 1/4 of my adult fertile years (I didn't fool around as a minor), during the vast majority of which I used one form or another (or a combination). I can assure you that it had nothing to do with wanting to be equal with a man or viewing my body as fundamentally inferior. ; )

I don't know why Dr. Helen had a heart attack. Neither does she, apparently, based on what she wrote on her blog. Her doctors don't seem to know either, and generally speaking, that's to be expected. In the comments section of the blog, there's some speculation, by Dr. Helen, of factors that may have played a role. This is part of what she wrote:

Doctors told me I probably had a coronary spasm which women are prone to due, I think, to smaller arteries. Docs say perhaps a blood clot got caught in one of these arterial spasms and caused the heart attack. I was on birth control pills at the time and was told that could possibly have caused the blood clot

So it seems the connection between Dr. Helen's heart attack and her use of birth control pills is pretty tenuous: her heart attack may have been caused by a blood clot that may have been caused by using birth control pills.

Rational people don't read that and conclude that Dr. Helen's "heart attack was probably caused by birth-control pills." Only people who don't understand the difference between "probable" and "possible" would reach the conclusion Glenn Reynolds has reached based on that information.

Thanks Maybee. That makes sense. This talking point is all over Facebook and no one is challenging it. I guess this is an example of how the Limbaugh controversy really hurt the conservative argument. Instead of pointing out the inaccuracies everyone is talking about Limbaugh's stupid rant.

I guess this is an example of how the Limbaugh controversy really hurt the conservative argument. Instead of pointing out the inaccuracies everyone is talking about Limbaugh's stupid rant.

Nobody made people pay more attention to Limbaugh than Fluke's testimony.Fluke's story was out there for a day before Limbaugh said what he said, right?How many people did you see question her "facts" then?How many of her interviewers have asked her about them?

The "war on women" is what the Dems wanted to go with from the beginning. They never intended to present facts in pursuit of a new entitlement. If you weren't demanding the facts, then you played into their hands. That isn't Rush's fault.

Canuck's big concern was that medical uses for hormone pills should be covered in the US healthcare system, where he does not live.Once he finds out they are, and that concern is ill-founded, he goes on to wondering what commenters here use.

I think it's quite possible that a whole bunch of people out there weren't even *aware* of Fluke's testimony until *after* the Limbaugh stuff hit the fan. In a sense, the latter helped bring the former into the public consciousness, but unfortunately in a negative way.

(I'm not referring to myself, or others, who have been following the whole mandate thing, in all its permutations, for a long time. But most folks, including those who vote etc., have not.

This is why the Limbaugh thing is so very unfortunate and was so ill-conceived, IMO.

Obviously, most of you here disagree. I'm aware of that, and I get and respect [most] of your arguments to the contrary.

Bender, you can spin and twist whatever you want to fit your worldview and impute motives to other people. Have a grand old time at it, I say! Which you no doubt will, and more power to you.

That doesn't make you right, and it certainly doesn't make me have to listen to you.

(I must say, I'm devoutly grateful that I have very conservative, devout Catholic friends, including a best friend of decades, in my life.

Because if I were only exposed to conservative Catholics who expressed themselves in the way and with the attitude and the tone that you do, I'd run as fast toward the far hills from Catholicism as I could. Instead, I have deep respect for and interest in Catholic theology, for the Catholic church and for most conservative Catholics.

You are no good witness, at least online, to those who don't already agree entirely with you in content and form.)

But I think your statement that people hadn't heard about Fluke until the Rush thing pretty much proves my point.He didn't distract from the larger, better crafted argument.He was just used as another stop on the "Republicans have a war on women" express.See, for example, Obama's fake permission slip. He's the president. Much more powerful than Rush.

I was on BC for four years after I married, completely unschooled in any side effects. (Totally ignorant - this was before internet - I didn't even understand how they worked - I feel sad, now.) I have been off of them for 12 years. I have heart troubles and thyroid issues since then.

When I first went off of them, I was a total mess for a few months. I felt completely emotionally unstable, and of course physically sick.. My husband was shocked at this strange creature in his house.

They tended to destroy libido - what a waste of my twenties! What a sad early marriage! It wasn't all bad, but after they were out of my system, I felt like I did when we were dating.

I dislike very much when people speak up about side effects and are labeled mysoginistic or anti-feminist. Being fully informed is so important.

I am sorry to hear you say that, rcommal, and it is true that all too often I am too forceful in my comments. Enough so that I have had to mention it in Confession. So for saying or doing anything that might lead you away from what is true, I apologize.

But in the interests of such truth, trying here to be as delicate and gentle as possible, a woman's body is, in her natural state, fertile. To respect a woman in her natural state and dignity is not wrong.

And to adopt an attitude that woman in her natural state is somehow a type of illness that requires taking "medication" to suppress that natural state of being is to adopt an attitude that is against woman as she truly is.

Why should women have to change who they are? Why should they have to be the ones to fundamentally alter their bodies with powerful hormones, chemicals that seek to advance a lie about women's bodies?

Why not demand that men be men and insist that they be the ones to change?

When studying a NFP method, it can be very graphic. So it someone is so uptight about their body, they will fail at it. Not only is there a study on a woman's changing cervical mucus through out her cycle, one can even observe the change of her cervix.

TMI

For instance when a woman is non-fertile her cervix is firm, but when she is fertile it slightly higher and becomes softer.

If her partner knows this, he can actually tell how fertile she is at the time of intercourse. Politely said, if your husband's erect penis is long enough to reach to your cervix. He knows when your fertile and when you're not.

A lot of assumptions here. And I don't know why people think they know my gender. :)

Anyways - different opinions are great! If you think the pill causes women to loose attraction to certain men that's fine with me. Still don't know what to make of the penis envy comment.

And it explains these comments--which to me sound odd--if I understand the commenter--and likely his wife--isn't and never will be a consumer of the pill. It also explains to me other reactions and comments in other threads that I did not understand.

It doesn't make me uncomfortable--but then I'm already aware of NFP principles.

What I can't get my mind wrapped around is how I would possibly have been able to keep a straight face, much less burst out in uncontrollable giggles, had I personally had to sit through a public school class in which we were putting condoms on cucumbers.

The film in high school health class during which Adrienne Barbeau (!!!) was snapping a condom was bad enough, believe me--especially given that it was co-ed (and this was in the 1970s, for crying out loud!). The only that saved me was that my parents were always very open and direct in educating us children.

That, and biting my lip *really, really, really* hard. And doodling like crazy on the handouts--HOORAY for MARGINALIA!

OK. Back to the more serious (I don't mean to threadjack).

MayBee:

I take your point (have taken your point), but Rush really did just bring out the ammo and hand it over gift-wrapped with a big old, bright-red bow. No one made him do that. He's an adult. He's intelligent. He could have foreseen it, IMO, and, honestly, no one can convince me otherwise.

Bender: Thanks. I do know and appreciate the philosophy behind what you just said--and also the way you just put it. : )

Anyone claiming to be a "libertarian" should recognize that they don't necessarily have the expertise to make any sensible judgment about how an individual patient and doctor make decisions on what's best for the patient. There is birth control available at low prices at pharmacies, and people are free to buy it. I have no problem with some people making that choice, but that isn't the best choice for everyone. I'm unimpressed with "libertarians" who are suggesting that a one-size-fits-all solution is preferable to individuals and their doctors making their own medical decisions on a case-by-case basis.

"The film in high school health class during which Adrienne Barbeau (!!!) was snapping a condom was bad enough, believe me--especially given that it was co-ed (and this was in the 1970s, for crying out loud!). The only that saved me was that my parents were always very open and direct in educating us children."

Oh.

Then, you probably should go see that bathroom in NYC in which some artist, now long since dead of AIDS, did a seemingly endless drawing of penises in various states of deployment; I'm pretty sure there are no condoms depicted, to test your squeamishness.

And it explains these comments--which to me sound odd--if I understand the commenter--and likely his wife--isn't and never will be a consumer of the pill. It also explains to me other reactions and comments in other threads that I did not understand.

If someone decides the pill is not for them, does that mean they shouldn't debate whether it should be mandated in the US that nobody should have to pay for female contraception out of his own pocket?

I wonder if using birth control pills will eventually be shown to change the kind of men women are attracted to.

"Animal studies show that female mammals can smell out males whose MHC genes are different from their own. MHC genes affect important immune responses. By mating with males who have different MHC genes, females give their offspring a better disease-fighting repertoire.

It's true of humans, too. In laboratory studies, women who sniff men's sweaty T-shirts find them more attractive when they come from men whose MHC genes don't match theirs. It's not that certain MHC genes smell better to women -- it's the difference that counts.

The result: After taking the pill, women shifted toward preferring genetically similar men. Women who did not take the pill slightly increased their preference for genetically different men.

John Stodder said...And isn't it funny that even now, 50+ years after it was introduced, we still call birth control drugs "the pill" or "pills?"

60+ years actually. Carl Djerassi co-invented of the first oral contraceptive for women back in 1951. He had a long career at Stanford University (he's since retired). He's also long been interested in the arts and even writes fiction.

Djerassi foresaw the Pill's huge social impact, anticipating a far greater social impact on men than on women. He apparently also foresaw the so-called "feminization of men," along with changes in laws and social values in favor of women in society as a whole. I put a link to that here

Chuck66 said "According to the Democrats, it isn't the availability of birth control pills, its that women shouldn't have to pay for them. That someone else should pay for their birth control."

I think they just want birth control pills covered under their health insurance plans like any other prescription med. And even if it's employer sponsored plan it is part of their compensation so they are in effect paying for it. I would think insurance companies would need to charge more for plans that did not provide this coverage. After my second child was born I had a vasectomy. I would never want my partner to have to take the pill one day longer than necessary. Under the Blunt amendment, coverage for that procedure would also not be available. What we get here is a tiny minority of people (and notably not most Catholics) who want to dictate family planing choices to everyone else. We should understand that this will truly only effect those at the lowest economic strata which begs the question of the consequences of this policy. I really love Catholic Bishops lecturing the American public about morality.

I think they just want birth control pills covered under their health insurance plans like any other prescription med.

Who wants this, Mark?Not the Obama administration, which just mandated birth control pills be treated very very differently than other prescription meds.They also did not mandate vasectomies be covered at all.

[Mark:] I think they just want birth control pills covered under their health insurance plans like any other prescription med.

[MayBee:] Who wants this, Mark?Not the Obama administration, which just mandated birth control pills be treated very very differently than other prescription meds.They also did not mandate vasectomies be covered at all.

I think you're both incorrect.

Mark, the regulation stipulates that birth control be zero-copay, that is, no marginal cost to the plan-holder. That is not how other prescription meds are handled. If you need a medication that treats something actually wrong with you, like, oh, hypertension or high cholesterol or chronic pain or diabetes, you generally do have to pay something for it. You can, however make yourself deliberately infertile for free.

And even if it's employer sponsored plan it is part of their compensation so they are in effect paying for it.

Cool. Then you would have no objection if the employer canceled the plan and just gave everyone a raise in take home pay?

That way each employee could chose the level of coverage or not to be covered if they want.

Right???

Under the Blunt amendment, coverage for that procedure would also not be available. What we get here is a tiny minority of people (and notably not most Catholics) who want to dictate family planing choices to everyone else. We should understand that this will truly only effect those at the lowest economic strata

Ummm. No.

The Catholic Church is concerned ONLY with the policies and mandates that affect themselves. There is nothing in this current kerfluffle that affects anyone outside of the Church or those who are voluntarily employed by the church.

If you are in the lowest strata and therefore, probably not working and not covered by a group employer sponsered plan AND not able to buy your own coverage.....there are plenty of places that will gladly provide you with birth control and with even abortions.

Even Catholic employers already pay large amounts of money in wages to their employees.

Those employees are perfectly free, in the exercise of their privacy, to spend $10-50 per month on contraceptives if they so choose.

By what rational basis is it necessary for the employer to take that same $10-50 per month and, instead of paying it to the employee, paying it to some insurer so that the insurer can then pay it to some pharmacist?

How does that enhance anyone's freedom or privacy to involve all of these extra people in the private sex lives of employees?

I think they just want birth control pills covered under their health insurance plans like any other prescription med.

Who wants this, Mark? Not the Obama administration, which just mandated birth control pills be treated very very differently than other prescription meds.

Really? From Kaiser's ACA description:Insurers will also have flexibility in how they actually cover certain benefits. For example, all plans will have to include prescription drug coverage, but the formularies that specify which drugs are covered will vary. The federal guidance requires only that plans cover at least one drug in each class (e.g., antidepressants, drugs to lower cholesterol, protease inhibitors for HIV, etc.). This is somewhat different from federal standards for Medicare prescription drug plans. Medicare plans must cover at least two drugs in each class, and for six protected categories – antidepressants, antipsychotic drugs, anticonvulsant drugs, cancer drugs, immunosuppressant drugs used by transplant patients, and antiretroviral drugs used by patients with HIV – all or substantially all licensed drugs must be covered. Plans also will have different networks of providers and different ways of managing access to providers and covered services.

Insurers quickly agreed to the compromise of providing pills for free if an employer objects because it was in their actuarial best interest. Tell us MayBee what percentage of the population believes family planning prescriptions should be eliminated from private health insurance plans. This has been required in some states for a long time without controversy. I've been buying health plans for 37 years and I've never seen that provision nor ever heard it was available. The simple reason is that it would be disadvantageous for the insurer.

After my second child was born I had a vasectomy. I would never want my partner to have to take the pill one day longer than necessary. Under the Blunt amendment, coverage for that procedure would also not be available. What we get here is a tiny minority of people (and notably not most Catholics) who want to dictate family planing choices to everyone else.

Mark, coverage for a vasectomy would be available from any insurer that chose to cover it. (I'm reading over and over these past few days that babies are expensive and preventing them isn't; why wouldn't they cover your snippage?)

It would also be available w/o coverage, if you were willing to pay for it yourself. (It's an outpatient procedure, as I understand it, and not terribly expensive.)

What it would not be is free to you. Nor would a tubal ligation be free to your wife. Oddly enough, just about every other medical procedure but those two that either of you might undergo would cost you something out of pocket under PPACA, as would any medications but birth control. Were you to need any sort of surgery but getting yourself snipped, you would pay actual money for it.

Does this policy make sense? We require copays for every medicine that treats actual diseases, and every surgery that treats actual harm, but anything that artificially induces sterility is free.

She does have a PhD in, I believe, psychology, and is likely to have been the one to have done much of the actual work in determining the most likely cause of her heart attack. Assuming that a law professor is incapable of that sort of think, which you seem to believe is the case.

Do you have a link on vasectomies, because the rule as written has been interpreted otherwise, at least by insurers.

No, I have no link, and thank you for yours. I'm afraid I just assumed both male and female sterilization were included, partly because it would be silly to leave out vasectomies when tubal ligation is considerably more expensive (and invasive, and risky), and husbands and wives are generally both on the same insurance plan. But I guess sense doesn't really come into it, does it?

Not really. I don't think prescription meds are sprayed with pesticides. I'll grant you LSD though-- scary because it's made by some dude who spends half his time evading the police. I'll try a lot of drugs, but LSD has never held much appeal to me.

Tell us MayBee what percentage of the population believes family planning prescriptions should be eliminated from private health insurance plans.

What difference does this make. The issue is forcing a religious institution, no matter WHAT percentage they are to provide items and services that they find morally objectionable and that would violate their religious principes.

This has been required in some states for a long time without controversy. I've been buying health plans for 37 years and I've never seen that provision nor ever heard it was available.

Sure it is. BUT, most States have also provided an opt out provision for religious institutions.

And most States also allow levels of coverage. For instance you should be able to buy a policy that does NOT include maternity.

And until now, or with the imposition of Obama care, you used to be able to. The difference now is that ALL plans will be forced to carry coverage. Whether the consumer wants it or not and whether the employer wants to offer or not.

What I find interesting is that all the anecdotes people tell about the pill, pro or con, have no bearing on whether it should be prescription or not. There seems to be some idea that Doctors are magicians.

Putting aside the pill and looking at other drugs, it seems to me that the primary purpose of the prescription market is to force people to make token visits to the doctor, often so the doctor can peddle you more drugs!

A good pharmacists can be very helpful in understand drug interaction, so I've no problem of still requiring many drugs to be purchased through a pharmacy, just without a prescription.

Why not let me sign away my right to sue the pharmacy and drug company and let me buy the long term drugs I need? (Which for me is sold OTC, only in lower doses at a slight markup BUT HSA rules no longer let you buy OTC drugs.)

I disagree with the idea that it should be OTC. Hormones are nothing to mess with, and women who take the wrong dosage pill get all kinds of trouble.

Also, I think it's fine to require religious institutions to provide the pill--but only if it's medically necessary. A fair number of women take the pill to regulate their hormones, and in that instance it should be no different than a doctor prescribing cholesterol meds. We need to separate the issues of the pill for medical necessity versus the pill for recreation--that would tend to clear up the political arguments.

And most States also allow levels of coverage. For instance you should be able to buy a policy that does NOT include maternity.

And until now, or with the imposition of Obama care, you used to be able to. The difference now is that ALL plans will be forced to carry coverage. Whether the consumer wants it or not and whether the employer wants to offer or not.

Or whether you're post-menopausal or not. Or have had your tubes tied. Or, for that matter, are male.

A fraction of the US population that would be called an "overwhelming majority" if it were in the context of an election is physically unable to get pregnant, and that's not even counting the women who are taking contraceptives. But, maternity coverage for all. It's totally fair, sir; you have the same coverage as anyone if you get pregnant.

I have never quite understood why it's totally OK to discriminate against men in setting auto insurance rates, but not OK to discriminate against women in health insurance rates.

It's uncontroversial that men have more car accidents than women do; it's equally uncontroversial that women run up more health care costs than men do. Pregnancy, for starters; living several years longer, for another. Men more often die in conveniently quick fashions, like workplace accidents, or murder, or suicide, and they die several years earlier on average than women do. Women are more likely to be running up big Medicare tabs in a nursing home.

Michelle Dulak Thomson wrote: I have never quite understood why it's totally OK to discriminate against men in setting auto insurance rates, but not OK to discriminate against women in health insurance rates.